Retiree Health & Welfare
Retiree Health and Welfare Benefit Summaries
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Covered Features
Anthem HMO is one of the three medical plans available to eligible participants in certain areas of California. The plan is not available to members for whom Medicare is primary. -
Choice of Providers
Must use only Anthem HMO Health Plan Providers -
Plan Maximums
No plan maximum -
Out-of-Pocket Maximums
$1,500/individual
$3,000/for 2 family members
$4,500/for 3+ family members -
Doctor Visits or Hospital
Your co-payment is:
$25 per visit
No Charge -
In-Patient Hospital Co-Pay
Your co-payment is $250 per confinement.
No charges for surgeon or assistant surgeon. -
Anesthesia
$35 co-pay per occurrence -
Emergency Room Co-Pay
Your co-pay is $100 for bona fide emergencies. Waived if admitted. -
Ambulance Services
$50 co-pay per trip. -
Outpatient Lab and X-Ray
No charge -
Preventive Health Care
(Routine check-ups, well baby care, immunizations, preventive screenings, etc.)100% preventive care coverage is available in accordance with the Affordable Care Act. Click here for more information. -
Prescriptions
Co-Payment for Generic Co-Payment for Name Brand Retail Pharmacy on Recommended Drug List $10 per 30-day supply $30 per 90-day supply Mail Service Pharmacy on Recommended Drug List $20 per 90-day supply $60 per 90-day supply Retail Pharmacy not on Recommended Drug List $30 per 30-day supply 50% per 90-day supply Mail Service Pharmacy not on Recommended Drug List $60 per 30-day supply 50% per 90-day supply -
Mental Health and Substance Abuse Treatment Benefits
$250 co-pay per admission.
Detoxification covered for Substance Abuse. -
Contact Information
Website: www.anthem.com
Phone: (800) 522-0088